A Phase II Study to Evaluate the Efficacy and Safety of Oral Ceritinib in Patients With ALK-positive NSCLC Metastatic to the Brain and/or to Leptomeninges

Approximately 160 patients diagnosed with ALK-positive metastatic NSCLC (according to the 7th
edition of the AJCC [American Joint Committee on Cancer] Cancer Staging Manual) and active
lesions in the brain and/or diagnosed with leptomeningeal carcinomatosis will be included in
the study, approximately 40 patients in Arm 1 and Arm 2, approximately 30 patients in Arms 3
and Arm 4, and approximately 20 patients in Arm 5. Additional patients may be enrolled in Arm
4 to achieve approximately 60 patients in Arms 3 and 4 together (i.e. ALKi naïve patients),
if enrollment rate in Arm 3 is slow.

- Arm 1 will include patients with metastases in the brain without evidence of
leptomeningeal carcinomatosis, previously treated with radiation to the brain and with
prior exposure to an ALKi.

- Arm 2 will include patients with metastases in the brain without evidence of
leptomeningeal carcinomatosis, previously untreated with radiation to the brain but with
prior exposure to an ALKi.

- Arm 3 will include patients with metastases in the brain without evidence of
leptomeningeal carcinomatosis, previously treated with radiation to the brain but with
no prior exposure to an ALKi.

- Arm 4 will include patients with metastases in the brain without evidence of
leptomeningeal carcinomatosis, previously untreated with radiation to the brain and with
no prior exposure to an ALKi

- Arm 5 will include any patients with leptomeningeal carcinomatosis with or without
evidence of active lesion at the baseline Gadoliniumenhanced brain MRI. Note: Previous
treatment with ALK inhibitors other than crizotinib is not allowed in Arms 1, 2, and 5.

Ceritinib will be administered orally once daily at a dose of 750 mg (five 150 mg capsules)
on a continuous dosing schedule. The treatment period will start on Cycle 1 Day 1.

Complete tumor assessments including gadolinium enhanced brain MRI will be repeated at Week 8
(on Cycle 3 Day 1) and every 8 weeks (i.e. every 2 cycles) thereafter or earlier if
clinically indicated. Safety evaluations will include (S)AEs, physical examination, vital
signs, ECGs, laboratory parameters and WHO performance status. Blood and CSF samples for PK
will also be collected.

Inclusion Criteria:

- Histologically or cytologically confirmed diagnosis of metastatic NSCLC according to
the 7th edition of the AJCC Cancer Staging Manual. In addition, the NSCLC must harbor
an ALK rearrangement, as assessed using the FDA approved Vysis ALK Break Apart FISH
Probe Kit (Abbott Molecular Inc.) test and scoring algorithm (including positivity
criteria). If documentation of ALK rearrangement as described above is not locally
available, a test to confirm ALK rearrangement must be performed by a Novartis
designated central laboratory. Patients must wait for the central laboratory result of
the ALK rearrangement status before initiating treatment with ceritinib

- At least one extracranial measurable lesion as defined by RECIST 1.1. A previously
irradiated site lesion may only be counted as a target lesion if there is clear sign
of progression since the irradiation.

- Patients may or may not have neurological symptoms but must be able to swallow and
retain oral medication. Be neurologically stable within at least 1 week prior to the
first dose of study drug.

- Patients may have received prior chemotherapy, crizotinib (other ALK inhibitors are
not allowed), biologic therapy or other investigational agents. Patients must have
recovered from all toxicities related to prior anticancer therapies to grade ≤ 1
(CTCAE v 4.03). Patients with any grade of alopecia are allowed to enter the study.

- Patient has life expectancy ≥ 6 weeks.

- Patient has a WHO performance status 0-2.

Patients in Arm 1 to 4 must also meet the following inclusion criteria:

- Patients must have active brain metastases from NSCLC, confirmed by Gadolinium-enhanced
MRI without concomitant leptomeningeal carcinomatosis. Dose of steroids must be stable for
5 days before the baseline brain MRI.

Patients in Arm 5 must also meet the following inclusion criteria:

- Patients must be diagnosed with leptomeningeal carcinomatosis.

Exclusion Criteria:

- Patients who need whole brain radiation to control the brain metastases. Patients will
not be eligible unless treated brain lesions are progressive or new brain lesions are
observed since the post whole brain radiation therapy MRI.

- Planning of any brain local treatment (including but not limited to surgery,
stereotactic radiosurgery, whole brain radiation, intrathecal chemotherapy) following
the administration of the first dose of study drug.

- Patient with a concurrent malignancy or history of a malignant disease other than
NSCLC that has been diagnosed and/or required therapy within the past 3 years.
Exceptions to this exclusion include the following: completely resected basal cell and
squamous cell skin cancers, and completely resected carcinoma in situ of any type.

- Patient has impairment of GI function or GI disease that may significantly alter the
absorption of ceritinib (e.g., ulcerative diseases, uncontrolled nausea, vomiting,
diarrhea, or malabsorption syndrome).

- Patient is receiving unstable or increasing doses of corticosteroids.

- Patient has other severe, acute, or chronic medical conditions including uncontrolled
diabetes mellitus or psychiatric conditions or laboratory abnormalities that in the
opinion of the investigator may increase the risk associated with study participation,
or that may interfere with the interpretation of study results.

Other protocol-defined inclusion/exclusion criteria may apply.